title: Addition of platelet concentrate to dermo-epidermal skin graft in deep burn trauma reduces scarring and need for revision surgeries.
abstract: BACKGROUND
  [corrected] Deep skin burn injuries, especially those on the face, hands, feet, genitalia and perineum represent significant therapeutic challenges. Autologous dermo-epidermal skin grafts (DESG) have become standard of care for treating deep burns. Additionally, human autologous thrombin activated autologous platelet concentrate (APC) has gained acceptance in the setting of wounds. While each of these interventions has been independently shown to accelerate healing, the combination of the two has never been evaluated. We hypothesized that the addition of platelets (source of growth factors and inhibitors necessary for tissue repair) to the DESG (source of progenitor cells and of tissue proteases necessary for spatial and temporal control of growth regulators released from platelets) would create the optimal environment for the reciprocal interaction of cells within the healing tissues.
  
  
  METHODS
  We used clinical examination (digital photography), standardised scales for evaluating pain and scarring, in combination with blood perfusion (laser Doppler imaging), as well as molecular and laboratory analyses.
  
  
  RESULTS
  We show for the first time that the combination of APC and DESG leads to earlier relief of pain, and decreased use of analgesics, antipruritics and orthotic devices. Most importantly, this treatment is associated with earlier discharges from hospital and significant cost savings.
  
  
  CONCLUSIONS
  Our findings indicate that DESG engraftment is facilitated by the local addition of platelets and by systemic thrombocytosis. This local interaction leads to the physiological revascularization at 1-3 months. We observed significant elevation of circulating platelets in early stages of engraftment (1-7 days), which normalized over the subsequent 7 and 90 days.
authors.affiliation: Institute of Radiodiagnostic and Vice-President for Science and Research, University Hospital Ostrava, Czech Republic.
authors.forename: Vaclav
authors.initials: V
authors.lastname: Prochazka
authors.forename: Hana
authors.initials: H
authors.lastname: Klosova
authors.forename: Jiri
authors.initials: J
authors.lastname: Stetinsky
authors.forename: Jaromir
authors.initials: J
authors.lastname: Gumulec
authors.forename: Katerina
authors.initials: K
authors.lastname: Vitkova
authors.forename: Dana
authors.initials: D
authors.lastname: Salounova
authors.forename: Jana
authors.initials: J
authors.lastname: Dvorackova
authors.forename: Hana
authors.initials: H
authors.lastname: Bielnikova
authors.forename: Petr
authors.initials: P
authors.lastname: Klement
authors.forename: Veronika
authors.initials: V
authors.lastname: Levakova
authors.forename: Tomas
authors.initials: T
authors.lastname: Ocelka
authors.forename: Lubomir
authors.initials: L
authors.lastname: Pavliska
authors.forename: Pavel
authors.initials: P
authors.lastname: Kovanic
authors.forename: Giannoula Lakka
authors.initials: GL
authors.lastname: Klement
mesh_terms: D002056:Burns / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002921:Cicatrix / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D011537:Pruritus / Q000188:drug therapy / Q000209:etiology; D012086:Reoperation; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods*; D014463:Ultrasonography; D014945:Wound Healing